Thrombolytic stroke therapy: past, present, and future.

Until 1995, treatment of strokes consisted exclusively of efforts to prevent recurrence. Proof that tissue plasminogen activator is useful for acute management is changing the approach to stroke patients. The development process has been difficult and the current treatment recommendations have been controversial. Recent successful clinical trials lend additional credence to these concepts. Future treatment strategies will probably include combinations of thrombolytics and neuroprotectants of various types. However, the need to initiate treatment rapidly after stroke onset is likely to continue.